Minister Dick – Our Service deserves better funding

Gympie has a model of palliative care that ticks all the boxes – early access to palliative care, true 24/7 access to professional nursing care and support, a model that values the pivotal role our local Doctors play in the initial diagnosis, treatment and ongoing care of their patients with a terminal illness and access to the Sunshine Coast Specialist Palliative Care Service for patients with more complex clinical needs. The relationship between GP’s and Little Haven’s Nurses is one of mutual professional respect fostered across many years, working together to give our patients the best possible quality and quantity of life, provided at the right time in the right place.

Little Haven has consistently struggled for adequate funding for the service we provide to all who seek our care. Below is a copy of recent communications with Health Minister Cameron Dick, requesting a meeting ‘

… “as a Palliative Care Qld Board member and Business Manager of Little Haven – an exceptional community based service which has saved QHealth millions of dollars across the years. I would appreciate an hour of your time to explain why Little Havens model of community based palliative care is not only world’s best practice and should be allocated equitable funding from the existing pool of PC funds, but also how our model of care could be rolled out across other regions in Queensland. Doing that would not only make Queensland a leader in Palliative care, it would also save QHealth a fortune.”

– which he declined, instead sending us back to the local health service district to plead once again for a better share of scripting funding. (Apparently it’s also protocol in the ministers office to sign emails using first name only). This meeting with Mr Kevin Hegarty and Dr Louise Welch will take place next Wednesday afternoon. Wish us luck.

Personally I think we deserved a better response from the Minister for Health and Ambulance services than this.

Thank you for your request to meet with the Minister. Unfortunately the Minister is unable to meet with you and has asked that the Chief Executive of the Sunshine Coast Hospital and Health Service meet with you on his behalf. We have forwarded your email to them and asked that they contact you soon to arrange a convenient time.

I am writing to you as it appears that you are the only person who can help Little Haven Palliative Care, the primary provider of community based palliative care services in the Gympie region.

Our issue is that despite a 37-year history of providing a nationally recognized model of home based Palliative Care that see’s 60% of terminally ill patients dying in their own homes (verses a national average of 14%) with a further 24% passing having spent less than 5 days in hospital we are being starved of adequate QHealth funding.

Over a 10 year period (2006 to 2016) the demand for our service has grown exponentially and has been largely funded by the community. During that period QHealth has contributed $1.82 million leaving a funding gap of $4.02 million raised within our community. The funding gap in 2016/17 financial year has grown to $600,000. This is not fair, sustainable or even sensible considering the amount of money we are saving QHealth by keeping people out of hospitals and in their own homes.

Over the last 12 months these are the steps we have taken to have Queensland Health address this issue.

Numerous meetings and discussion with Sunshine Coast Hospital and Health Service Specialist Palliative Care Service (SCSPCS) who visit our region on a fortnightly basis. All have been met with the same answer ‘There’s no money available’. Their advice to us to scale back our on call 24x7x365 days a year in home nursing care by decreasing the area we cover, only admit patients with a 3 month prognosis or limit the number of admissions by closing our books, are completely unacceptable.

In one conversation with the Director of SCSPCS, Dr Louise Welch, I was told that “your funding model (project funding of $255k annually) is antiquated and they would like to get rid of it but know there would be a community outcry if they did.”

After many years of requesting it – I finally was granted a face to face meeting at QHealth HQ with Anthony West and Racheal Vowles from the Community Funding Unit. In that meeting encouragingly they both acknowledged what an outstanding service Little Haven Palliative Care provided BUT informed me that “increased funding for Palliative Care is not on the QHealth agenda”. Aside from my views on how Palliative Care in the QHealth system is moving towards a far more expensive and difficult to access clinical model, I asked “Is freeing up hospital beds also not on Qld Healths agenda?”

Currently Little Haven is caring for 78 palliative patients in the community at an approximate cost to QHealth of $700 / day (Total – not per patient). Should just one of these patients not have access to community based palliative support and end up in hospital the cost would be upwards of $1600 / day.

With the help of our local federal MP Lew O’Brien, on Tuesday the 28th of March I participated in a conference call with MP David Gillespie – Federal Assistant Health Minister regarding our widening gap in funding. His response was the Federal Government provides the states with considerable funding for palliative care including funding for home based palliative care. I understand he will also be making representation to your office on our behalf.

The ‘penny dropped’ when I read an article in The Gympie Times on March 3rd 2017 under the heading “Why Most Gympie Residents won’t die a good death” (Incorrect but that’s a separate issue). In which you are quoted as saying:

Health Minister Cameron Dick said each hospital and health service was best placed to determine how their share of the palliative care funding was spent.

“It is important that decisions regarding models of care and distribution of funding are made by local clinicians – and administrators ensure services best address the needs of their community,” Mr Dick said.

Now I understand – with $87m allocated to the state’s 16 hospital and health services for palliative care in 2016 – 2017 there is actually no shortage of money for Palliative Care. Rather the responsibility for allocating those funds has been given to QHealth local clinicians and administrators whose interest is being served by building their own resources at the exclusion of non QHealth organisations who have served the Health system so well. It is these decision makers that are driving people into hospitals instead of keeping them out of them. Please allow me to take a little more of your time to give you just one example.

Whilst we have been repeatedly told by the SCSPCS there is no money for scripting the patients they refer to us, we have seen them recently employ and deploy 2 Nurse Practitioners to the SC Health District at considerable cost – greater than our entire funding. When I’ve enquired what their role would be and where did they see the gap in services here? Their response “they can write scripts” – (why when the GP’s already do this?) and “we are still working on a position description”

We have also been told there will be 2 new Palliative Care Nurse Navigator positions commencing shortly.

These positions offer no after-hours support, instead direct people to Dove House or the Gympie Hospital. It is our nurses who are there at all hours to support these patients, managing complex clinical symptoms under the direction of the GP or the specialist, keeping patients out of hospital.

Despite Little Haven having a service agreement in place with the Sunshine Coast Hospital and Health Service for provision of community based palliative care, of the 78 patients currently under Little Haven’s Care – 33 of which are known to the Specialist Palliative Care Service for management of complex clinical needs, we only receive scripted funding for our nursing visits for 4 of these patients. I’m sure you’ll agree this is hardly fair and equitable or reflect your comments in the Gympie Times articles.

Nor is it fair that we pick up the patients sloughed by the health system, without recognition for our support. In the week leading up to Christmas, as the local hospitals started emptying out their beds, Little Haven received 8 new referrals. When we said we were feeling overwhelmed we were told Blue Care was not taking new patients and they had to be discharged back to the community. This brought the number of patients in our care up to 80. Two of those patients passed away on New Year’s Eve and two on the 2nd Jan – supported by our nurses in locations up to 70 kms from our base. Consequently over the very expensive holiday period (when better funded facilities rationalised their costs) our on call nurses worked in excess of 12 hour days, which had devastating effect on our already stretched budget.

Of course we had no obligation to take on these patients but what option would have been available for these poor families had we not been there. That’s the value of true compassionate community engaged care providers.

Hence Minister I am requesting a meeting with you, as a Palliative Care Qld Board member and Business Manager of Little Haven – an exceptional community based service which has saved QHealth millions of dollars across the years. I would appreciate an hour of your time to explain why Little Havens model of community based palliative care is not only world’s best practice and should be allocated equitable funding from the existing pool of PC funds, but also how our model of care could be rolled out across other regions in Queensland. Doing that would not only make Queensland a leader in Palliative care, it would also save QHealth a fortune.